Gallbladder Volvulus: A Case Report and Review

Table of contents

1.

Abstract-Gallbladder volvulus is an unusual cause of acute abdomen. After the first case published by Wendel, about 500 cases have been documented in the medical literature.This condition is defined as torsion of the gallbladder around its The one presented here is a case of a 85 year-old woman who complained of right subcostal pain since 48 hours without fever.

-walled gallbladder which was ischemic and gangrenous without perforation.

Cholecysectomy was performed with a cho langiography which was normal. The anatomopathologic examination confirmed the diagnosis of acute gangrenous cholecystitis. Gallbladder volvulus is a non-frequent cause of acute cholecystitis.

2. I.

Case Report 85 year-old woman was admitted for a right upper abdominal pain, nausea, vomiting without abdominal surgery or trauma, laboratory analysis revealed hyperleucocytosis with normal liver function tests. The echography revealed thick-walled gallbladder without cholelithiasis and a common bile duct dilatation of 10 mm. Right upper quadrant tenderness and positive Murphy's sign were detected on physical examination. On surgical exploration through a right subcostal incision, there was a 100 ml of serohemorrhagic exudate with complete torsion of the gallbladder along the axis of the cystic duct (figure1), the cystic duct was so long which measured 6 cm, it is cut at a distance of 1 cm of the c ommon bile duct, introperativecholangiography was normal (figure2), standard open choecystectomy was performed. Bile culture was positive for Echerchia Coli, therefore; antibiotheraby was adapted. Her p ostoperative c ourse was uneventful, and she was discharged on the3 rd postoperative day.

3. Discussion

Gallbladder volvulus is defined as torsion of the gallbladder around its artery and duct in case of a long and flask mesentery (1). After the first case published by Wendel in 1898(2), about 500 cases have been documented

-old patients (3,4). Gallbladder torsion occurs most often in elderly patients (5,6,7), but several cases were rep orted in children (8,9). The one presented here was a surprise intraoperative diagnosi s because of the presumed gallbladder volvulus commonly presents as acute cholecystitis and is rarely diagnosed preoperatively. This condition should be always suspected when making the patients especially in women. Magnetic resonance cholangiopancreatography (MRCP) i s very useful in making preoperative definitive diagnosis of gallbladder torsion (10). Gallbladder torsion was reported in pregnancy (11). Gallbladder volvulus should be thought suitable medical treatment. Delayed diagnosis can lead to dangerous c omplication such as necrosis and perforation of the gallbladder with a generalized peritonitis,consequently;mortality is increased especially in elderly patients who have often other comorbidities (5). laparoscopic detorsion and removal of gallbladder is the treatment of choice for gallbladder volvulus (4,12).

4. III.

5. Conclusion

Gallbladder volvulus is a rare cause of acute abdomen which i s rarely diagnosed before surgery. It should be added to the differential diagnosis of acute cholecystitis that does not improve after medical treatment especially in elderly women. Early diagnosis and urgent cholecystectomy in necessary for optimal prognosis.

Volume XIV Issue V Version I Year ( )

Figure 1.
gallbladder detortion is performed, fever since 48 hours.She had an insulin The echography revealed a large thick intraoperative view of gallbladder torsi on, B hemorrhagic exudate with complete torsion of the gallbladder dependent diabetes with no history of previous Laparotomy through a right subcostal incision revealed a sero with a common bile duct diameter of 10mm without stones. Gallbladder Volvulus: A Case Report and Review Mounzer Dgheem ? & Charles Mouliade ?
Figure 2. Figure 1 :
1Figure 1 : A)
Figure 3. Figure 2 :
2Figure 2 : Intraoperative cholangiography shows the long cystic duct with no stones in common bile duct II.

Appendix A

  1. Gallbladder volvulus: rep ort of two original cases and review of the literature. A A Shaikh , A Charles , S Domingo , G Schaub . Am Surg 2005 Jan. 71 (1) p. .
  2. Gallbladder torsion: report of four cases and review of the literature. A Marano , E Yahchouchy-Chouillard , R Spinelli , A Iannelli , T Aura , A Fingerhut . Asian J Surg 2002 Apr. 25 (2) p. .
  3. Laparoscopic treatment for torsion of the gallbladder in a 7-year-old female. A Matsuda , K Sasajima , M Miyamoto , H Maruyama , T Yokoyama , S Suzuki , T Matsutani , A Sugiura , K Yanagi , A Matsushita , H Arai , T Tajiri . JSLS 2009 Jul-Sep. 13 (3) p. .
  4. A case of floating gallbladder and kidney complicated by cholelithiasis with perforation of the gallbladder. A V Wendel . Ann Surg 1898. 27 p. .
  5. Uncommon cause of ac ute abdomen: volvulus of gallbladder with necrosis. Case report and review of literature, C Bagnato , P Lippolis , G Zocco , C Galatioto , M Seccia . 2011 Mar-Apr. Ann ItalChir. 82 p. .
  6. Torsion of the gallbladder in pregnancy. A case report. K Kleiss , L Choy-Hee , R Fogle , M Lindsay . J Reprod Med 2003 Mar. 48 (3) p. .
  7. Preoperative diagnosis of gallbladder torsion by magnetic resonance cholangiopancreatography. M Usui , S Mat Suda , H Suzuki , Y Ogura . Scand J Gastroenterol 2000 Feb. 35 (2) p. .
  8. Gallbladder volvulus: review of the literature and report of a case. O R Tarhan , I Barut , H Dinelek . Turk J Gastroenterol 2006 Sep. 17 (3) p. .
  9. Volvulus of the gallbladder: laparoscopic detorsion and removal. SurgEndosc, S Y Kim , J T Moore . 2003 Nov. 17 p. 1849.
  10. Volvulus of the gallbladder: laparoscopic detorsion and removal. SurgEndosc, S Y Kim , J T Moore . 2003 Nov. 17 p. 1849.
  11. Diagnosis and treatment of gallbladder torsion in a 6 year old. T C Farnsworth , C A Weiss . JSLS 2013 Apr-Jun. 17 (2) p. .
  12. Complete bodyneck torsion of the gallbladder: A case rep ort. T W Pu , C Y Fu , H E Lu , W T Cheng . World J Gastroenterol 2014 Oct 14. 20 (38) p. .
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Date: 2014-01-15